Hearing before the Committee on Public Health on dangers to human life from bacilli in milk

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PUBLICATIONS

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Massachusetts Society for Promoting Agriculture.

HEARING

BEFORE THE

COMMITTEE ON PUBLIC HEALTH

Dangers to Human Life from Bacilli
of Tuberculosis in Milk

FEBRUARY, i89i

BOSTON

WRIGHT & POTTER PRINTING CO., STATE PRINTERS

18 Post Office Square

1891

CONTENTS.

Page

Statement of Thomas Motley, Esq 3

Dr. Harold C. Ernst 3

Dr. Abbot 17

Dr. Ernst 18

Dr. Clark 20

Dr. George B. Loring 23

A. W. West, Esq 24

Dr. Ernst 25

Dr. Loring 28

Dr. Abbot 28

Dr. Clark 31

HEARING.

Room 14, State House, Boston, Mass.
Feb. 2, 1891, 10.30 a.m.

Mr. Gilman (the Chairman). — Mr. Clerk, will you please
read the petition ?

(The petition is read by the Clerk.)

Mr. Thomas Motley. — As President of the Society for
Promoting Agriculture, I will simply state this. We desire,
for the purposes of this hearing, that Dr. Ernst may read his
report, and that Dr. Austin Peters may also read his report.
We have prepared no regular bill ; but we desire to ask the
Legislature to do something to protect the inhabitants from
this trouble, and also to protect the farmer, that he may not
be made to suffer either. I do not know that there is any-
thing more that I have to say now. At the proper time we
shall probably present a bill. I will ask Dr. Ernst to address
the Committee.

Dr. Harold C. Ernst. — Mr. Chairman and Gentlemen
of the Committee : For something like three years, at the
instance of the Trustees of the Society for Promoting Agri-
culture, it has been my duty to conduct a series of experi-
ments bearing upon the question which they have placed
before you this morning. Previous to presenting to you the
results of the experimental evidence which we have gath-
ered during that time, it seems to me that a few words in
regard to the importance of this investigation might make
the subject a little clearer, and may furnish a reason for the
movement which has been taken in this matter.

The Chairman. — Allow me to ask, right here, — for this
is a question of some importance, — have you a condensation
of your thoughts that you could submit to us in type- writing,
or in any way ?

Dr. Ernst. — I think that you have that, sir, in the report
already in your hands. In addition to what there is in that

report, the tables of the experimental work, which are of no
practical value so far as the reading is concerned, have been
prepared ; but I think you will find in that report all that is
necessary.

In regard to the importance of this investigation, that is
something which will be readily seen when it is considered
that tuberculosis is th£ most wide-spread disease which affects
humanity. It is unquestionable that, in all civilized coun-
tries, at least one-seventh of the deaths from all forms of
disease in human beings are due to this one thing. It is
also true that tuberculosis is one of the most common dis-
eases among cattle which are used for a milk supply, — that
is to say, among cattle which are kept under confined condi-
tions ; and the results of investigations for the last seven or
eight years have shown distinctly that this disease is due
to a special micro-organism, that the disease occurring in
human beings and in cattle is exactly the same, and that, by
inference, the occurrence of the disease in cattle used for a
milk suppky helps on the occurrence of the disease among
human beings. Whether that was true or not was the
question which was put before us as the expert investigators
of this Society to determine.

In regard to the wide-spread nature of this disease there
is hardly a person in any civilized community who cannot
name some member of his family who has been attacked by
it. It is not confined, as is popularly supposed, to the lungs.
Tuberculosis of the lungs is commonly known as consump-
tion ; but it occurs in all parts of the body, — as surgical
tuberculosis of the joints, as tuberculosis of the membranes
of the abdominal organs, as the localized skin disease called
lupus, which is precisely the same thing as tuberculosis oc-
curring elsewhere, except that it is located in the skin, and
as the dreaded disease called leprosy, to keep which disease
from our shores such active measures have been taken by
the Boards of Health, — for leprosy, I have little doubt, will
within a short time be included under the head of tubercu-
losis. There is but one small link in the chain of evidence
connecting leprosy with tuberculosis wanting; and to the
minds of those who are expert on this question there is little
doubt to-day that lepros}- is a form of tuberculosis. These
facts illustrate, it seems to me, very markedly the impor-
tance of an investigation of this kind.

Now, the importance of such an investigation having been
determined, the question is, How is it that the disease arises?
and that can be stated very briefly. I have brought here
illustrations of the cause of the disease ; and I have them
here, in microscopic preparations, under the microscope on
the table. Here I have photographs of the micro-organism
which produces the disease, as you see there. (Photo-
graphs shown.) I have also the organism in the living
state, the culture being placed in this copper tube, so that
it cannot be broken.

The evidence in regard to the cause of tuberculosis has
been accumulating only for about eight years. Before that
time its infectious principle was merely suspected. The first
definite evidence of its infectious nature was offered only
twenty-five years ago by Villemin, a Frenchman. It had
been suspected before that, but the first scientific evidence
of it was not offered until that time. But the infectious
principle, the cause, of the disease was entirely unknown
until the announcement of Robert Koch, of Berlin, who,
after a long series of experiments, proved beyond a shadow
of a doubt that tuberculosis is due to the activity of a mi-
nute organism included among the bacteria; in other words,
that the " bacillus of tuberculosis " is the cause of this
disease in all its forms, no matter where they occur. It is
produced by this organism. It is never produced de novo.
It always comes by reason of the entrance of this organism
into the human body, and it is distinctively and emphatically
an infectious disease.

Now, this organism is one which it is not easy to destroy.
It retains its vitality under a number of different conditions.
Drying will not destroy it. One of the most remarkable
series of experiments that I know of in regard to that fact
has been conducted in my laboratory by Dr. A. K. Stone,
in which this organism, after an extreme degree of drying,
has been shown to retain its vitality and infectious prop-
erties for a period of three years and a half at least. The
results of these experiments are about to be published in
pamphlet form, and will come out in the course of a few
weeks.

In regard to the infectious nature of tuberculosis, there
can be absolutely no doubt.

As to the literature on the subject, I have here something-
like two thousand references to articles written in all lan-
guages, and in different parts of the world, bearing upon and
proving the infectious nature of tubjeiculosis ; and these
articles include only the literature extending over about
the past seven years. Of course it would be absurd to at-
tempt to read to 3^011 what these different authorities say on
the subject, but here is a list of the literature collected ; and,
if any one needs further proof, he will only require to look
at a few of the articles on this subject here collected.

The infectious nature of tuberculosis being settled, then
comes the question of how the disease is spread ; and, speak-
ing generally, there are three ways in which this occurs :
in the first place, by the inhalation of dried expectoration,
which is present in all our streets and in all civilized com-
munities ; and this accounts for the common occurrence of
tuberculosis of the lung, or consumption, because this dried
expectoration is such a common matter in the streets of
our cities. It is only within a few 3-ears that the importance
of controlling the expectoration of tuberculous material in
the streets has made itself manifest even to medical gentle-
men. At the same time, when it is recognized that every
time a person having tuberculosis of the lung expectorates,
he also scatters abroad an indefinite number of these bacilli
in active vitality, it will be seen to be an extremely impor-
tant matter.

The next method of spreading this disease is by direct
inoculation ; that is, by these bacilli of tuberculosis effect-
ing an entrance through a lesion either of the skin (which
would be called a " cut," of course, with something in-
fected with tuberculosis material) or through the mucuous
membranes of the mouth or other parts of the body. One
of the most perfect illustrations of how this is brought about
is under my charge to-day, — a case of localized tuberculosis
of the tongue. A gentleman, perfectly well Thanksgiving
Day, so far as he knew, in some way, by eating something
infected with tuberculosis, became infected with tuberculosis
of the tongue, because he has or has had (for I am glad to
say that he is better now) a nodule half as large again as
an English walnut, which is pure tuberculosis, as was shown
under the microscope in a piece taken off with the use of
cocaine.

The third great method of spreading the disease is by
means of the ingesta, or by means of the material that passes
through the digestive organs. In this case it is not so easy
to diagnose as in the case of tuberculosis of the lung, but it
is very common. That being the case, and it being true
that, from a priori reasoning, a method of spreading this
disease can occur through the ingesta, it takes but very little
thought to direct our minds toward the special means of its
transmission. And, in thinking what is the most universal
food that is employed in civilized countries, one does not
need to hesitate a moment before saying milk. It is the
only animal product which we use uncooked, in a raw con-
dition. It is the one thing which is used by old and young,
in all civilized countries. It is the thing upon which we
feed the babies ; and it is important, particularly for their
sakes, that an investigation should be carried out, in order
to show whether or not it may contain the virus of the dis-
ease.

Now, the suspicion having been aroused that milk may be
a vehicle for the transmission of tuberculosis, how shall we
prove it? In this connection, it seems to me that it would
be quite proper to speak of the investigations of Dr.
E. F. Brush, of Mt. Vernon, N.Y., who has taken up this
question of the infectiousness of milk for the last few years,
not especially from the experimental side, but from the sta-
tistical side; and, judging from a paper which he published
last year, as the result of investigations carried on for a num-
ber of years before, and extending through the statistics of
the world, he certainly believes himself, and seems to show,
that tuberculosis does not exist among people that do not
employ milch cattle. Certainly, it is a coincidence — whether
it is the actual fact or not we are unable definitely to say
but this is what he shows — that tuberculosis does not exist
excepting in countries where ordinary milch cattle, milch
kine, as distinguished from goats, etc., are used for furnish
ing the milk supply. His papers are scattered through the
New York Medical Journal, and I can give you the refer-
ences if 3>"ou care for them : they are all here.

Now, as another side of his investigations, he shows that
in countries where the milk supply is derived from goats or
from mares there is no tuberculosis, which follows out per-

fectly the natural history of the disease, because neither
goats nor mares are affected by tuberculosis.

The Chairman. — Would the presence of milch cows
where the milk was not used, but where the flesh was used,
produce the same effect ?

Dr. Ernst. — No, sir. I shall have a little to say later
about the infectiousness of tuberculous meats.

The Chairman. — Why I ask the question is because I
have a country and a people in mind where cattle are plenty,
but where the inhabitants seldom drink the milk, and yet
those people have a good deal of tuberculosis.

Dr. Ernst. — You must remember that, in this discussion,
we do not exclude other sources of infection. I am simply
trying to show that milk may he a source of infection for
tuberculosis. It should be borne in mind that another source
of infection, by means of inhalation, is quite as active, even
where milk is used as a food.

In endeavoring' to show whether milk from cattle affected
with tuberculosis contains the infectious principle or not,
scientific investigations would be divided into two classes ;
and those classes would include, in the first place, matters
of opinion and, in the second place, matters of fact.

Now, in regard to matters of opinion. Before coming
before a committee of this kind with any claim whatever, it
seemed to me that one of the first things that the Committee
would want to know would be, " What do other medical
gentlemen think in regard to this question ? " and, in order
to satisfy that inquiry, even before it is asked, I will say
that about a year ago 1 sent out a circular letter to some-
thing like two thousand medical and veterinary men. I
sent it to every member of the Massachusetts Medical
Society of five }Tears' standing. I sent it also to members
of the American Surgical Association, the Association of
American Physicians, and one or two other special medical
societies in different parts of the country. Dr. Peters fur-
nished me with a list of the veterinarians ; and I sent to
members of the United States Veterinary Association, receiv-
ing a very large number of replies. The letter which I sent
out read as follows. (The letter is read.) The letters that
were collected are here ; but it is not, of course, proper that
I should take up your time in reading them all. I have

summarized the conclusions, in order that I might give you
some idea of what the medical men think of this question.
A number of the letters are of very great interest. But it
should be said, in summarizing them all, that out of the
twelve or thirteen hundred answers that I received there
were but two which expressed an absolute disbelief in milk
as a vehicle for the virus of tuberculosis ; there were a large
number of gentlemen who expressed their belief in it; a
large number who stated, what is perfectly true, the diffi-
culty of proving such a thing, but expressed their belief in
it ; and a comparatively small number who furnished me
with cases which they believed were distinctly traceable to
the milk coining from tuberculous cows.

I have records of cases of probable infection of children
from the milk of mothers with tuberculosis of the lung- and
mamma. I have cases of the infection of children from milk
coming from a tuberculous cow. I have a large number of
cases from the veterinarians, showing the infection of calves
from tuberculous cows ; and it seems to me impossible to
resist the conclusion that, notwithstanding the fact that the
attention of medical men has not been attracted to this point,
excepting within the last year or two, the amount of evi-
dence obtained from the clinical side is very great.

With your permission, if I can find one letter, I will read
it to you. This is a letter which is dated Cheraw, S.C.
(The letter referred to is read.) That is, of course, a letter
not bearing distinctly upon this question of the infectious-
ness of milk from tuberculous cattle ; but, it being granted
that the disease is the same in human beings as in cattle, the
inference is irresistible that the same thing may come from
the milk of tuberculous cattle, provided that we can show
that that milk contains the virus. I have other letters here
giving an account of children who have become affected with
tuberculosis as the result of using the milk of tuberculous
cows; but the one which I have just read happened to strike
my eye, and so I gave it.

Another point in our investigation related to the exist-
ence of tuberculosis among people not usiiig milk from tu-
berculous cattle, or exercising care in its use ; and it was
thought that, if such people existed, it would be a matter of
interest to learn whether tuberculosis occurred among them

10

to any extent or not. In our own community we have one
distinct class of people who are supposed to exercise care in
the selection of the meat they use, — they are the Jews, —
and, of course, it is a matter of interest to discover whether
the Jews are as much affected by tuberculosis as people of
other religions. To that end, Dr. Henry Jackson, who has
worked with us in these investigations, has collected the
facts, which, with your permission, I will present to you.
Beginning his article in this way, he goes on to say that
•w among the replies received by Dr. Ernst, in response to a
circular sent out in Ma}r, 1890," — that, of course, should be
January, 1890, — uas to the frequency of tuberculosis," etc.,
(reading the article referred to). That seems to indicate
that tuberculosis is less common among the Jews.

The Chairman. — Do the Jews not use milk?

Dr. Eknst. Only when it comes from cattle that have
been carefully inspected. That is precisely the point upon
which we are working to-day: that among people who use
milk only from cattle that have been carefully inspected tu-
berculosis is less common. It seems to be less common
among the Jews. We are endeavoring to show that milk
from tuberculous cattle is infectious ; and it is true that Jews
do not use milk, excepting when it comes from cattle that
are known to be healthy, or at least from cattle over which
some supervision has been exercised with a view to deter-
mining the condition of their health.

The Chairman. — Do you mean to say that the Jews do
not use the milk which is commonly sold by the Boston
milkmen?

Dr. Ernst. — I do not mean to say that that is so abso-
lutely. I mean to say that, if the Jews act in accordance
with the laws of Moses, they do not take milk from the
regular milk-dealers in Boston, excepting when they know
its source to be healthy.

Now, having dealt with the matters of opinion with refer-
ence to the infectious nature of milk from cattle affected by
tuberculosis, my next series of evidence will be in regard to
matters of fact, as shown by the experimental evidence
which we have to place before you.

In settling any such question as this of the infectiousness
of milk coming from tuberculous cattle, a research must of

11

necessity be extremely difficult of accomplishment ; and
that is one reason why I have brought the preparation of
the bacillus of tuberculosis and placed it under the micro-
scope for your inspection, in order to demonstrate to jow
the minute size of the organism producing the disease. Nec-
essarily, the search for the virus must be a search for the
bacillus of tuberculosis in the milk which is supposed to
contain it ; and, after you see the minute size of this or-
ganism and recognize that one way of proving its presence
is the actual seeing of it, it will be very easy for you to un-
derstand how difficult such an investigation as this is, and
why it would have been perfectly possible for us not to have
been able to present any statistics at all: whereas, on the
other hand, we can show you a good deal. The difficulty
of finding the organism is very great in milk : there is no
chemical way by which its presence can be shown. The
first way to prove its presence is by seeing it ; and the sec-
ond way to prove its presence is by means of the results of
inoculations.

Now, we have carried out these two kinds of experiments',
and, as it seems to me, pretty thoroughly. The method of
doing so has been made possible only by the liberality and
the public spirit of the trustees of the Society which I rep-
resent. There has been no such investigation carried on in
this or any other country before. It is an expensive matter,
and one that must be carried on without the probability of a
return for the money invested. It may be like throwing
money into a hole, without ever securing or expecting any
return. But, notwithstanding that fact, the Society, having
secured a farm situated in a healthy locality in the country,
have given every possible support that could have been de-
sired to the work. The farm was placed under the most
perfect hygienic conditions. Of course the methods which
are used are technical, and of little interest to the Commit-
tee ; but that is the fact. It was, in the first place, in a
healthy exposure : the drainage was made perfect, and the
buildings were put in excellent repair, and in perfect condi-
tion from a scientific point of view ; and that farm was sup-
ported during all the time that was necessary for reaching
these results. The cows that were selected for experiment
were kept there ; and the beneficial effect of such treatment

12

as they received is only a further illustration of the point
that we are trying to prove, that good hygienic surroundings
should be required for all milk-giving cattle, because cows
that were brought there in the poorest sort of condition, suf-
fering from tuberculosis, either did not lose any more, or else
they gained, and, in certain cases, apparently got well. All
of which goes to show what can be done by careful super-
vision of cattle that are used for milk supply.

In these investigations, our first point was to secure cattle
that were affected with tuberculosis, but not of udder, the
because the infectiousness of milk ivhere tuberculosis has at-
tacked the milk glands has been acknowledged for years,
but we desired to go a step further, and show, if possible,
whether the milk from cows affected with tuberculosis in other
parts of the body than in the udder also carried the virus, the
udder being healthy ; and, therefore, the cows which were
collected at our farm were selected with that special point
in view. Dr. Peters exercised a great deal of care, and took
a great deal of time in hunting up animals fit for this sort of
experiment.

Then, having obtained the cattle, we carried out, in the
first place, a long series of microscopic examinations of the
milk obtained at different times from the different cattle,
making one hundred and twenty-six such examinations ; and
a single microscopic examination of milk for the bacillus of
tuberculosis means three or four days' work. It means the
preparation of a large number of " cover-glasses" ; it means a
careful search of each one for a long time, varying from five
minutes, if you find it, to an hour, if you do not find it ; and
of course it is extremely trying upon one's patience and
one's eyesight. But, as a result of that investigation, out
of one hundred and twenty-six series of " cover-glasses,"
in searching for the organism, the bacillus of tuberculosis, in
milk coming from cows having no tuberculosis of the udder
at all (as was shown and demonstrated by a post-mortem
examination of the cows), we found it present in the milk
in sixteen instances. In other words, we found it present
in thirteen per cent, of the examinations that we made.

Now, considering the difficulties of finding it at all, this is
to my mind a startlingly large percentage.

We collected evidence of the infectiousness of this milk

13

by another series of experiments, — by inoculations of the
same milk in a series of guinea pigs and in a series of
rabbits ; and as a result of that treatment, of the inoculation
of the rabbits, — we inoculated seventy-four, — in six out of
those seventy-four we produced tuberculosis. That also is a
remarkable statement to my mind, when it is remembered
that the inoculation amounts to the subcutaneous injection
of only from one to three drops of the milk ; and it means
that a little over 8 per cent, of the rabbits experimented
upon were shown to be tuberculous after having been treated
with this milk.

Dr. Reade (of the Committee). — Was this an injection
of prepared milk, or did you take it just as it came ?

Dr. Eknst. — Just as it came, — sometimes of the milk and
sometimes of the cream. That is a secondary question. It
can be differentiated by reference to the tables of the inocu-
lations ; but the result shows that the virus may be present
in either the milk or the cream. After the cream has been
separated, it is just as likely to be virulent as the milk.

The second series of experiments was made upon guinea
pigs, and a little larger percentage was obtained. Out of
seventy-seven animals inoculated there were ten in which
tuberculosis was produced ; that is to say, in a little over
13 per cent, in the case of guinea pigs. It should be said
that the question of previously existing tuberculosis in these
animals, and the source of error that might arise from that
fact, was guarded against as carefully as can ever be done
in such investigations as this. The animals were kept under
observation for a long time before they were inoculated at
all, and they were selected particularly because of their
healthy condition.

Then we had, as a second series of experiments, to show
this virulent condition of the milk coming from the cattle
affected with tuberculosis, a series of feeding experiments ;
and we fed a series of animals with the milk coining from
the cows of which I have spoken. We have here a complete
table, a complete record, of all the cows that were used for
experiments, showing where they came from, how long we
had them under observation, and what the results were of
the post-mortem examination.

Dr. Reade (of the Committee). — Did you ever inoculate

14

any of these guinea pigs and rabbits with milk in which you
did not find bacilli?

Dr. Ernst. — Yes. This — the inoculation of the milk —
is one of the ways by which we endeavored to determine the
presence of the virus.

Dr. Reade (of the Committee). — I mean in any of these
cases that you have spoken of, where you took a given
number of rabbits or guinea pigs?

Dr. Ernst. — Yes. It was the milk of the cows at the
farm, and it was done for the purpose of determining the
presence of the virus. Even if we do not discover it under
the microscope, it might be there ; and we did the inoculation
experiments in addition to our examinations under the mi-
croscope, for the purpose of determining whether the virus
was there.

For the feeding experiments a litter of twelve health}* pigs,
born of healthy parents, were fed with the milk from cows
that we had used for experimenting in other directions ; and,
out of these twelve pigs, five showed tuberculosis — that is,
almost fifty per cent. — in the feeding experiments.

We also used twenty-three calves for feeding experiments.
Calves that were born of healthy parents were taken before
they had had milk from other sources at all, within twenty-
four hours of the time of their birth, and placed upon the
milk of these cows that we had at the farm ; and, of these,
eight became tuberculous by the feeding experiments.

There were other feeding experiments made, such as I
have spoken of, upon a series of rabbits ; and of those there
were but two that showed definite tuberculosis. There were
several others that were suspicious.

And, then, also a series of feeding experiments were made
upon guinea pigs, the results of which are not properly col-
lated, so that I cannot place them before you.

As a matter of interest, it seemed quite a proper thing to
attempt to discover whether it were possible to show the ex-
istence of this virus in the milk supply of the city of Bos-
ton, as it is furnished by the dealers, — whether, mixed as it
is. diluted as this virus must of necessity be (because, of
course, in a herd, it is not reasonable to suppose that all the
cattle used for milk supply are affected with tuberculosis),
if there were only one, and the milk from that cow were

15

veiy strongly infected with the bacillus of tuberculosis, and
then were mixed with the milk from a number of other cows,
the virus would be much diluted. The question was whether
we should find it present at all ; and, to prove that, or as
one of the investigations, we took a series of samples of milk
that were collected by Dr. Charles Harrington, the inspector
of milk for the city of Boston, and made a similar series of
investigations upon the milk obtained in that way to the
investigations upon the milk from the cows at our experi-
mental farm. And, in one ease under the microscope, and in
another case by inoculation experiment, we distinctly showed
the presence of this virus of tuberculosis in the milk as it is
supplied through the milk-dealers.

An important part of the importance of our results is in
regard to the existence of tuberculosis among the cattle that
are used for milk supply in this part of the country ; and,
at my request, Dr. Peters, who is the Society's veterinarian,
has written this report, which is submitted to you, and
which is the report which you have in your hand, sir, and
which you may easily read. The discussion is an extremely
interesting one ; but the conclusion to be obtained from it
is that tuberculosis in cattle is quite too prevalent for the
safety of the public health, — in cattle that are used for the
milk supply in this part of the country.

Then, as a matter of interest, I have here a series of
photo-micrographs, which }'ou may like to look over. They
do not show much to one who is not accustomed to appear-
ances under the microscope, but they are photographs of
material which has been obtained in this investigation.
They are photographic evidence of what we have ascer-
tained, and the results obtained are visible to any one who
chooses to look at them.

The results of all this, I think, can be summarized in a
few conclusions.

In the first place, — -and it almost goes without saying, —
tuberculosis is distinctly an infectious disease. It is classed
as such in France. There is there an absolute prohibition
against the disposal of milk from tuberculous cows, against
the sale of n^eat from tuberculous cattle of any kind.

In the second place, as the result of the work that we have
been doing, it is distinctly shown, and to my mind very em-

16

piratically proved, that the milk of cows affected with tuber-
culosis may contain and does contain the virus, no matter
how extensive or to how small an extent disease may exist
in the animal furnishing the milk ; and the corollary from
that, as shown from the evidence which I have here sub-
mitted, as it seems to me, is that the proportion of this milk
that is virulent coming from cattle, even with no tubercu-
losis of the udder, is greater than has thus far or until very
lately been suspected.

And, as a conclusion, as a result of all the work that has
been done in this direction in different parts of the world,
and as a conclusion from this evidence which I have tried to
present to you, the virulence of this milk, it seems to me,
has been shown to be so possible that some sort of restriction
should be placed on milk coming from cows affected with
tuberculosis ; and I think that some such restriction is abso-
lutely demanded for the good of the public in general and
for the protection of the children of the poor in particular.

The Chairman. — I think that I speak the mind of the
Committee when I thank you for your very clear statement
of the matter, and for the manner in which you have avoided
technicalities and have given us plain information, which, I
think, will be very valuable.

Dr. Ernst. — I have endeavored to do so, I am sure. I
am very much obliged to you, sir.

Mr. Appleton. — We have invited many of the Boards of
Health within a convenient radius around Boston to be rep-
resented here. I do not know how many of them are present.
Perhaps some of these gentlemen have something to say.

The Chairman. — Is any one here representing Cam-
bridge ? Is any one here representing Somerville ?

Dr. Reade (of the Committee). — May I ask Dr. Ernst
one more question ? I should like to ask Dr. Ernst to state
a little more definitely in regard to the results of his exami-
nations of those specimens of milk that were taken from the
regular milk-dealers in the city of Boston.

Dr. Ernst. — In what way, sir ?

Dr. Reade (of the Committee). — You simply stated, I
think, that in two cases the bacilli were found ; J)ut you did
not state how large a proportion those two cases represented
of all the cases examined.

17

Dr. Ernst. — I did not do that, because the whole of the
examination is not finished ; and we may be able to find
more. We made fifty-eight sets of cover-glass preparations.
Now, those have not all been examined, because, as I have
said, the work is simply tremendous. But thus far, out of
those fifty-eight sets of cover-glasses, we have found the
bacilli in one. It would be hardly fair to give the result of
the complete investigation now.

The Chairman. — But you do not hesitate to make the
remark, do you, Dr. Ernst, as I have it here, that it is dis-
tinctly shown in the milk, and that the proportion of the
virus is much larger than is generally supposed?

Dr. Ernst. — No, sir : I do not hesitate to say that at all.
All that I meant about the milk supply in the city of
Boston was that in one instance, under the microscope, we
had seen the bacilli, and that in one case of inoculation with
a specimen of this milk we produced tuberculosis. I did not
intend to say anything about the proportion, only that we
did succeed in finding the bacilli there.

The Chairman. — Dr. Abbot, the Committee would be
very glad indeed to hear from you.

Dr. Abbot. — I will say, Mr. Chairman, that I have not
heard the discussion that has already taken place ; but the
necessity of some supervision in this direction, I think, is
quite plain. I have seen the need of this.

The Chairman. — I may say, sir, recognizing that you
have just come in, that the substance of it is given in the
last remark which Dr. Ernst made, that there are distinct
traces of bacilli in milk which is supplied to the people in the
city of Boston, and that there is very much more tuber-
culosis in the milk than is generally supposed, and that it is
really an impending danger threatening the health of the
community, particularly of the children of the poor.

Dr. Abbot. — I think that there is no question as to the
truth of that statement. Of course, the milk supply is one
of the most important food supplies that we have. It begins
with the life of the children, and a large number of children
are dependent upon the milk of cows ; and we know very
well that the health of such children, as compared with the
health of those who are fed from their own mothers, is very
much poorer, and that their death-rate is greater. Whether

18

that simple question depends on tuberculosis, of course, I
could not say ; but it is certain that tuberculosis may be — I
think that it is conceded now that it may be conveyed in
this way, as one of the modes of infection. Of course, it is
conveyed in a great many ways to human beings ; but, as
this is one of the methods that can be controlled to a certain
extent, it certainly is an important matter, and one which
measures should be taken to control *

The Chatrman. — Is Dr. Harrington's report as milk
inspector printed ?

Dr. Abbot. — We have nothing to do with that. That is
a city report. Dr. Harrington has charge of the inspection
of milk in the city of Boston. We have, in a general way,
charge of the inspection of milk throughout the whole State,
in the cities and towns ; but that question of milk inspec-
tion, so far as we have had anything to do with it, has
been outside of this matter of tuberculosis, which is now
before the Committee. We have to deal merely with the
question of fraud. Of course, in some cases, we have to
deal with matters affecting the public health ; but we have
to deal more with the question of fraud than with the matter
of health, — that is, we have to do with the preventing of
fraud in the adulteration of milk. But the question of dis-
ease, as propagated through milk, is a tar greater and a far
more important one than the question of adulteration ; and it
is one which, I think, the State has tin- same right to control
and to supervise and inspect as it has in the simple case of the
standard of milk, — thirteen per cent, of solids.

The Chairman. — Anything else, doctor?

Dr. Abbot. — No, sir.

The Chairman. — Would any member of the committee
like to ask Dr. Abbot any questions?

Dr. Ernst. — Mr. Bowditch suggested that I particularize
a little in regard to certain facts which I have not presented,
because they are in the different reports that I have read}' to
lay before you ; but there is one case in particular that is a
very striking illustration of the dangers coming from this
milk, and which was brought to my notice by the kindness
of Dr. Gage, the City Physician of Lowell. It occurred
last spring ; and it seems to indicate, as perfectly as anything
can, the necessity for some such legislation as we are asking

*Th2 italics are put in to show Dr. Abbot's emphisis.— h. c. e.

19

for. His attention was attracted to the subject, in the first
place, by reason of the letter which I sent out to so many
physicians, including himself, last year ; and, some two
months afterward, he very kindly sent to me specimens of
milk coming from a cow where tuberculosis was not sus-
pected. His attention was directed to it by reason of his
having under his care a child of less than a year old, that
had never been fed upon anything but the milk of this cow,
and was developing symptoms of tubercular meningitis;
and, after reading a report which I presented about that
time, the thought entered his mind, " May not this cow have
tuberculosis? and may not the milk from this cow, upon
which the child has been fed, have been the means of com-
municating the disease ? " Its parents were perfectly healthy,
there was nothing about the house which would account for
its condition, and the only theory upon which he could ex-
plain it was the possibility of this cow's being tuberculous.
He sent a specimen of the milk to me, and my assistants and
I found the bacilli of tuberculosis in the milk. ' We inocu-
lated four animals by a subcutaneous injection of anywhere
from three to six drops of this milk, and within six weeks
one of the animals upon which we experimented had acute
miliary abdominal tuberculosis, as you may see by the photo-
graph. Dr. Gage could find no way to prevent the sale of
the milk from that cow unless he bought and paid for her
out of his own pocket; and she is to-day, so far as I know,
used for a milk supply. Another child was fed upon- that
same milk, and was developing similar symptoms to those
discovered in the child who had died. I have here a photo-
graph showing the miliary tubercles in the abdomen. This
is as perfect a case as can be found in scientific literature.
It is very difficult to trace the cause and effect as closely as
is here clone.

Another case, which Mr. Bowditch reminded me of, was
that of a cow which had been selected by a gentleman for
the use of his baby, with the idea that one cow's milk (a
cow of the highest grade and breed) was the best supply.
We were carrying on this work, and, as a matter of interest,
the milk from that cow was sent to us for examination, and
in it we found the bacilli of tuberculosis Avithout any pre-
vious suspicion of disease. These two ^ire simph* special

20

cases. We have others that are quite similar in character
all through this evidence that I can present to the Com-
mittee.

Mr. Hemenway. — I should like to ask Dr. Ernst if he
supposes that sterilizing milk from a tuberculous cow would
remove the danger?

Dr. Ernst. — In reply to that, I should say, without mean-
ing to express any conceit, that, if I sterilized the milk my-
self, I should be satisfied ; but it is not a method that can
be applied generally with success. It is not a safe method
at all, particularly for the supply of milk to the poor, unless
something is done here similar to what is done in one or two
of the cities abroad, where the milk is sterilized for the poor
at the rate of eight, ten, or twenty thousand flasks a day.
But that, of course, is something that we cannot attempt.

The Chairman. — Is there any other gentleman present
now connected with any of the Boards of Health in the
vicinity of Boston that would like to say a word?

Dr. Clark. — I appear, representing the Board of Health
of the town of Medford. I will state, as a member of that
Board, that I have been brought into contact more or less
with tuberculosis in cattle, the existence of which is well
known to a number of the gentlemen here. We probably
have in Medford the worst stock farm in the State of Mas-
sachusetts or, possibly, in this country ; that is, I mean by
that that the cattle on this farm are probably diseased with
tuberculosis to a greater extent than the cattle on any other
farm. And, although we know that fact as far as any one
can possibly ascertain it, still our Board is powerless to rid
the community of that nuisance* if I may use that expres-
sion. And the reason for it is this: that the milk from the
cows kept on that farm is not sold in Medford. It is sold,
probably, in Boston or that portion of Boston called
Charlestown ; and of course, being disposed of in Charles-
town, the Medford Board of Health has no power or author-
ity whatever to exercise supervision over the disposal of that
milk. The cattle are fed upon refuse grain and swill ; and,
while they were quarantined last May, they were fed upon
their own milk. The place has been examined by several
physicians and several veterinarians, and they all pronounce
it as full of germl; and it is a place that will disseminate

21

disease among cattle, even if they are brought there in a
healthy condition. I bring this matter up merely for the
purpose of showing you that local Boards of Health have
absolutely no power to eradicate this disease, except so far as
it may be done by quarantining the cattle. The Cattle
Commissioners have seen the place ; and they feel this way,
that the Statutes are not sufficiently definite, that they do
not give them sufficient power to warrant their going ahead
and treating tuberculous cattle the same as they would treat
cattle affected by farcy or glanders or affected with con-
tagious pneumonia. The Cattle Commissioners claim — and
they take the ground properly, I think — that they hardly
feel warranted in killing cattle afflicted with tuberculosis ;
and they do not feel warranted in taking the same measures
that they would in the case of cattle affected with farcy or
glanders. If we take any action whatever, we can simply
isolate and quarantine the animals upon the premises of the
owner or remove them at the expense of the town.

Now, I think that, if an act were passed by the Legislat-
ure, whereby milk farms should be inspected by competent
persons, it would be a step in the right direction ; and I
believe, also, that the mere isolation or quarantining of ani-
mals is not a sufficient safeguard against the spread of dis-
ease. I believe that, if the animals are found to be diseased
with tuberculosis, they should be killed; and if, by any
chance, the animals that are killed should be found not to
have had the disease, I think, possibly, that the Statute
could be so worded that the farmer or the owner of the cows
or animals supposed to be diseased should receive a sufficient
remuneration. The trouble now is that, if an animal is
killed, unless there is an appraisal, the farmer gets nothing ;
and the farmers and those owning cattle do not take hold of
this matter in the way that they would otherwise, because
of the fact that they feel that, if their animals are killed, they
will receive no recompense whatever. If the Legislature
could devise some means whereby those who own cattle
which are killed, perhaps because of suspected tuberculosis,
and it is afterwards found that they did not have that dis-
ease, should receive some recompense for their loss, then I
think that the people generally throughout this State would
take hold of the matter in a better spirit than they do now.

99,

I think, perhaps, that one reason why they have not taken
favorably to the idea so far is because they have been igno-
rant of the contagious character of the disease.

I have listened with a great deal of interest to Dr. Ernst's
paper ; and I can speak of one case which came under my
notice in my own practice, of a person who contracted tu-
berculosis by the use of milk. That man came from healthy
parents, so far as I could learn. The family history was
without taint of tuberculosis. He purchased a cow which
he supposed was healthy, and he used the milk a year or
more. Last spring he showed symptoms of tuberculosis, and
the animal from which this milk was taken showed signs of
tuberculosis also. The cow has now been disposed of. I do
not know — lam not safe in saying — that the animal had
the disease, but every indication is that she had ; and that
man has to-day what is called consumption.

Now, as far as the prevalence of tuberculosis is concerned,
I can give you the certificate for the town of Medford for
the past ten years. We have had from one hundred and
ninety to two hundred cases of consumption, or tuberculosis.
That cause of death is the most frequent that we have in our
town. The next greatest cause of death is heart disease, of
which I think that we have had some ninety or one hundred
cases. So that you can see that tuberculosis prevails to a
greater extent, and causes more deaths in the town of Med-
ford, and has caused more deaths there within the past ten
years, than any other disease. That appears to bear out the
statement made by Dr. Ernst very well indeed.

As I have said before, I believe that there should be more
explicit legislation regarding the care of milk farms and the
sale of milk. We have our milk inspectors in large cities
and in some towns. In my town, they voted two or three
years ago to have a milk inspector ; but, when it came to
the appropriating of money to supply him with the necessary
articles for the performance of his duties and a proper salary,
the matter was voted down. What is required is direct
legislation requiring all towns — and I speak of towns more
particularly than cities, because I think that the inhabitants
of towns are perhaps a little more lax in matters affecting
their health than is the case with the inhabitants of cities,
not having been educated up to the necessities — requiring

23

all towns 'to have milk inspectors and inspectors of cattle.
I think that there should be a careful inspection, by com-
petent persons, of all cattle, more especially cows, kept on
the farms from which the supply of milk is obtained by the
community ; and, in case animals are diseased, they should
be killed. And, if it should be found afterwards that the
animals were not diseased, sufficient remuneration should be
made to the owner.

I believe that that is all that I have to say, Mr. Chairman.
That is my experience as a health officer in the town of
Medford; and, when I speak of the experience of the town
of Medford, I believe that I give the experience of the
majority of other towns.

The Chairman. — The Chair would like to state that the
House and Senate have adjourned until 2 o'clock. It is
now 12. The Committee are very anxious to get all the
information which they can upon this very important sub-
ject. If there is anything to be said upon the opposite side
of this question, the Committee want to hear it, and want to
give every gentleman an opportunity to speak. If the hear-
ing can be closed in three-quarters of an hour, well and
good. If not, I think that this matter is of sufficient impor-
tance to warrant our adjourning, in order to give every one
who desires an opportunity to be heard. I hope that you
will try to bear in mind that we are obliged to be in our
seats at 2 o'clock, and that we would like to have a chance
to get a plate of soup before then.

Hon. Dr. George B. Loring. — This paper, Mr. Chairman,
was not intended to antagonize anybody. I prepared it to
read to-morrow before the New England Agricultural So-
ciety, which Society I have addressed annually for the last
twenty-five or thirty years ; and I submit it without the
slightest feeling of antagonism, or the slightest desire to
overthrow anybody's facts. I submit it for the consideration
of open-minded and intelligent men, as coming from the best
scientists in this country and in Europe. After some pre-
liminary remarks, I go on to say : *•' Tuberculosis in animals
is evidently," etc., etc. (reading paper).

The Chairman. — Have you any suggestions, doctor?

Dr. Loring. — None whatever. I merely submit that
paper exactly as it is ; and I desire to say that I am very

24

glad to see that the investigations are going on with so much
care and diligence.

The Chairman. — Do you think that legislation is neces-
sary in regard to this matter ?

Dr. Loring. — I do not know what legislation is required.
If there is anything wanting to strengthen the hands of the
investigators, I should let them have it. It is very impor-
tant that we should know the origin of the disease ; and the
remedy we ought to find out, if there is any.

Dr. Ernst. — May I say a word or two in reply?

The Chairman. — I think that perhaps we had better
hear the opponents first, if there are any who desire to speak.

Mr. West. — I represent the Board of Health of Salem.
I only want to say that there have been within the last year
or two, or the last two or three years, two entire herds of
cows that supplied Salem with milk killed, and that they
were all found to have tuberculosis ; and, in my opinion, —
and I think that in this I speak for the Board, — some legisla-
tion, whereby these milch herds could be examined from
time to time by experts, would be of very great benefit to the
community. I have no doubt that the milk from those cows
was sold to Salem consumers for some time before the cows
were found to be suffering from this disease. We have a
milk examiner there, and samples of milk may be examined
for anybody that brings them in, free of charge ; but, as a
matter of fact, the year before last, not more than two or
three samples were brought in to be examined, although, as
I say, it is all done entirely free of cost to those who take the
samples for examination. I think that, if an act were passed
by the Legislature providing for the inspection of milch
herds by experts, it would be of great benefit to the commu-
nity at large.

Dr. Reade (of the Committee). — I should like to ask Mr.
West for what reason these herds of cows were killed ?

Mr. West. — On account of tuberculosis.

Dr. Reade (of the Committee). — Under what authority?

Mr. West. — I am not quite sure of the authority.

Mr. Appleton. — They were offered voluntarily by the
owners.

Mr. West. — I should also like to say that one of those
herds was comprised of the common grade of cows, — I think
grade Ayrshires.

25

The Chairman. — Is there any other gentleman here who
would like to speak on the affirmative side of this question ?
If not, Dr. Ernst has the floor again.

Dr. Ernst. — After listening to Dr. Loring's paper, and
jotting down a few things as he went along, it seems to me
that (without attempting to answer a number of other
points, which would appear to require dealing with more at
length after his paper shall have been put in print), in order
to prevent any possible misapprehension, certain misstate-
ments made by Dr. Loring during the reading of his paper
should be corrected now.

In the first place, I think that he made the direct state-'
ment that there is rlrst-rate authority for stating that tuber-
culosis is a self-generated disease. If there is any such
authority in existence, all that I can say is that his subse-
quent insinuation that the scientists in this part of the world
are not likely to receive for some time the reports of the
researches of scientists abroad upon the subject of tubercu-
losis, and that they are now presented by him (Dr. Loring)
for the benefit of the scientists in this country, is quite jus-
tifiable.

Dr. Loring. — Allow me to sa}- that I submitted that
statement to a scientist in Washington, and that he agreed
with me entirely.

Dr. Ernst. — I believe that I have the floor now, sir.

Dr. Loring. — I do not desire to take the floor away from
3tou, sir.

Dr. Ernst. — If there is such authority for that, we shall
all be interested to receive it. The only object of the trus-
tees, I believe, and of myself, is to get at the truth. We
have pursued this work very carefully for nearly three years ;
but, if that authority exists to-day — good authority, such as
would be accepted by scientific men in general — for the self-
generation of tuberculosis, I confess myself absolutely igno-
rant of its existence.

On the second point, I believe that the statement was dis-
tinctly made that the bacilli of tuberculosis do not multiply
outside of the body. Here are millions and millions and
millions of bacilli of tuberculosis which have multiplied out-
side of the body. (Culture of bacilli shown.) They do
multiply outside of the body. As bearing upon that, I will

26

quote an authority from this same University of Johns Hop-
kins, one of the best technicians of the day.

(Quotation from Dr. Abbot's work, showing advantages
of milk as a nutrient medium for the growth of the bacilli of
tuberculosis.)

It seems to me that it is not necessary — I had not sup-
posed that it was necessary in introducing this subject — to
go over all of the literature and all of the proof relating to
the matter; but these statements, so far as my knowledge
goes, are contrary to the accepted opinions of the best men
in this or any other country.

There has been a good deal said in regard to the statements
of the best veterinarians. I do not mean to natter, I do not
mean to say anything which is not fairly warranted, but the
best veterinary authority upon tuberculosis is sitting opposite
to me to-day, Dr. Austin Peters, of this Society. If he has
made any statement opposed to my views as expressed to-day
in regard to the existence of tuberculosis in human beings,
in regard to any of its characteristics in human beings, I am
entirely ignorant of it, and I hardly know how to answer the
suggestion that he has.

There was another statement made by Dr. Loring. It was
said by him that it was stated by a veterinary authority that
bacilli could not be found in the liver. That is the most
extraordinary thing that I have heard. Tuberculosis is one
of the most common diseases of the abdominal organs, and it
may be developed in the liver, the peritoneum, the mesenteric
glands, and almost anywhere. There are tuberculous nodules
in the liver shown in the photograph which you have before
you.

Another thing, — it seems to me as if the whole point of the
work which we have been doing for the Society — the whole
point of the work that was presented here this morning —
is ignored by Dr. Loring. We have worked two years and
a half or three years for the purpose of proving that the
milk from tuberculous cows is virulent, when there is no
tuberculosis of the udder. We state our results, and Dr. Lor-
ing says that there is no evidence. It is precisely the evi-
dence that Dr. Abbot quoted here as the article which I pub-
lished a year ago last spring, and which I have had the honor
paid me of having translated and published in Paris, — the
same article which was published in the Practitioner, in

27

Edinburgh ; — which was published by the Amherst Experi-
ment Station in a special edition, for the purpose of distribu-
tion among the farmers, and in the Centralblatt fur Bakterio-
logie in Germany. Certainly, some persons think this work
on milk is evidence. There is a little work done on this side
of the water, sir.

There Mas another point. Great stress was laid upon the
statistics of the United States Census. There were a little
over 90,000 deaths in 1880 from pulmonary consumption
alone, pulmonary tuberculosis, not including surgical tuber-
culosis, or tuberculosis in other parts of the body at all, so
that the number of deaths from the disease was much greater
than given by Dr. Loring. I am going to ask Dr. Abbot to
quote the statistics of this State in regard to tuberculosis.

Another statement made by Dr. Loring was that the ba-
cilli of tuberculosis have been found in tissues unattacked by
the disease. That is absolutely impossible. The actual pres-
ence of the bacilli in any part of the body denotes the disease.

Another thing, Dr. Loring spoke of the utility of the test
of injecting these bacilli of tuberculosis into the blood cur-
rent. The whole of our work for the last year has gone to
show the germicidal action of the blood upon bacteria ; and
it is proper to conclude that experiments by injections of
these bacilli of tuberculosis in the blood current are abso-
lutely of no value whatever, because of our increased knowl-
edge in regard to the germicidal action of the blood.

Still another statement which is made, and honestly made,
not only here, but in France and Germany and elsewhere,
that the cooking of meat destroys the bacilli. It destro}rs
them, certainly, on the outside ; but it does not destroy them
on the inside. Every experiment that has been made goes
to show that a piece of meat is precisely the same as a roll of
cloth. The outside, receiving a high temperature, is neces-
sarily affected by it ; but the desired result is not produced
on the inside for hours and hours. No roast of meat would
be disinfected on the inside by two or three hours' cooking.
That is accepted by certain authorities whom we believe in,
although Dr. Loring may not. And it is not true that the
gastric juice always destroys all forms of tuberculosis.

It seems to me that these statements should be corrected
before they are allowed to impress themselves too deeply
upon the minds of the gentlemen of the Committee. I be-

28

lieve that Dr. Abbot has certain statistics, which I should
like very much to have him read.

Dr. Loring. — I took most of my statements from a Massa-
chusetts veterinarian.* I did not ignore the veterinary sur-
geons of my own country- On the contrary, I gave them all
credit for the industry which they displayed in investigating
this matter. But I, for one, felt that it was an immense
question, involving almost the entire dairy property of Mas-
sachusetts. The remedy for it has not yet been suggested to
a sufficient extent to enable us to determine that our herds
are not in good condition. But, if they are not, and if cook-
ing does not remove the disease, as a certain veterinarian
has said, — I took the statement from him, — and if milk is
affected, the next question which arises is an economic ques-
tion of the utmost importance. That is the object that I had
in mind. I do not desire to reflect upon any surgeon or
scientist in my own country, or upon any surgeon or scientist
abroad. On the contrary, I gave them credit for what they
are doing ; and I simply asked them to continue in their
work as faithfully as they have in the past.

Dr. Abbot. — I have nothing to offer, except that, as Dr.
Ernst has requested a statement in regard to consumption in
Massachusetts, which you understand is not consumption in
cows at all, but simply among human beings, I will give it.
We do not know how much tuberculosis there is among
cattle. To discover that I understand to be the object of
this inquiry. It is not an easy thing to ascertain. I think
that it is a rather difficult one, especially in the early stages
of the disease in the cow. The same is true of the human
being; and all our information upon this subject must come
from the deaths that occur from tuberculosis in the State.
Those are all obtained from the Registration Reports, which
depend for their accuracy upon the individual certificates of
physicians who have attended upon persons that have died
either in families or in hospitals or elsewhere in the State ;
and, as Dr. Loring has stated, consumption is upon the de-
crease in Massachusetts. You will find, fortunately, that it
has been upon the decrease for — well, all that we know
about it is derived from the Registration Reports, which
cover a period of not quite fifty years, — since 1842 ; but the

* Misquoted Dr. Peters's article in the Ploughman.

29

earlier years I do not consider as verjr conclusive. The rec-
ords are rather incomplete for the first ten years, — at any
rate, the diagnoses were certainly not so careful then as they
are now; but I will say that, while the population has in-
creased, during the last two decades, certainly, more than
fifty per cent., the deaths from consumption have held their
own, the number of deaths has been about the same. But I
will give you the death-rate, which will be a more correct
way of looking at it ; that is, the number of deaths per
10,000 of the population. The average number of deaths per
year from pulmonary consumption, for the ten years from
1870 to 1879, was 33.4 per 10,000 inhabitants. In 1870 it
was 34.3. In 1871 it shows a slight diminution, — 33.9. In
1872 it was as high as 36.2. In 1873 it was 35.3 ; in 1874,
32.8; in 1875, 34.7; in 1876, 32.2; in 1877, 32.9; in 1878,
32.0 ; in 1879, 30.4, — the average for the ten years being, as
I have said, 33.4. From 1880 to 1889 there is a slight dim-
inution, the average for the ten years 1880-1889 being 29.7,
as compared with an average of 33.4 for the ten years 1870-
1879. But I do not, and I think that the physicians gen-
erally do not, take that as an indication that the causes of
consumption or tuberculosis are less prevalent than formerly:
that is simply a matter that we cannot explain. I do think
that the intelligence of the people as to the prevention of
consumption and the acknowledgment that it is an infec-
tious disease, — we know that it is an infectious disease, —
there is no doubt about it whatever, — we know that it can
be communicated from one person to another, from one ani-
mal to another ; we know that it can be communicated from
animals to men, and from men to animals,— that is a matter
that has been demonstrated time and time again — I have
seen it done, — as I say, I take the intelligence of the people
with regard to the ' prevention of consumption, and their
knowledge of its infectiousness, to be one of the explana-
tions, in the case of tuberculosis, as it is in the case of other
diseases, of this variation of the percentage shown by these
statistics. Many other diseases have diminished in that
same period, and others have increased. But I take it that
what we call the infectious diseases, the truly preventable
ones, have diminished very largely, because of the intelligence
among the people as to the modes of preventing the dissemi-
nation of those diseases.

30

Now, with regard to the difference in different counties of
the State : it is true that tuberculosis has prevailed to a
greater extent for the whole of this period in the eastern
counties than in the western counties. In 1880, the ratio of
deaths from pulmonary consumption to the total mortality
was, in Barnstable County, 18.28 ; in Berkshire County, the
other end of the State, it was 13.29 ; and in Dukes it was
20.00. But I do not consider Dukes and Nantucket as being
conclusive, because the population is very small, — only some
six thousand altogether. But tuberculosis, as I say, has been
more prevalent in the eastern than in the western part of the
State. The fact that the people are brought more closely
together in the eastern part of the State than they are in the
western part may have something to do with that. But, then,
again most of the large hospitals and institutions are in the
east ; and there are a great many people who come from the
western part of the State to these institutions to be treated,
and they die there. The difference in the climate, perhaps,
affects it to a certain extent. But I think that density of
population is not a cause of tuberculosis at all. It is simply
a condition. When you bring two men so near together that
they will infect one another, they are more likely to take
disease than they would be if they lived some way apart, as
they do in the western part of the State. Therefore, I say
that density of population is not a cause, but it is a condi-
tion : you put those men in a proper condition for the causes
to act.

The Chairman. — Doctor, would you make any comment
at all upon the fact of the decrease of consumption, the per-
centage of tuberculosis, among people, and the increase of it
among cattle, and milk, etc.?

Dr. Abbot. — I am not sure that we know that it has in-
creased among cattle and milk or not. ■ I do not think that
our records for the past years are conclusive upon that. It
is only within a very few years that we have known much
about the prevalence of tuberculosis among cattle from actual
post-mortem examinations. We know that it is prevailing
among them now, but I do not think that we really know
much about the extent to which it prevailed fifteen or twenty
years ago.

The Chairman. — Then you think that the statistics gath-

Q1

ered by the Agricultural College and the Boards of Cattle
Commissioners, etc., have not been sufficient to make a result
determinable ?

Dr. Abbot. — I think not. I think that we should require
to know the extent to which it has been prevalent among
cattle. I wish that this inquiry were broader, so as to in-
clude other things. Here is one thing that I think has not
been brought out : that a cow is the promoter of two classes
of diseases from herself to man. One is controlled by the
cow herself, that is, she has it in herself, like tuberculosis,
and possibly scarlet fever, as shown in Hendon in England ;
in the next place, diseases developing outside, — I do not
think that typhoid ever develops in a cow at all, but it is
possible for it to be propagated in milk. I traced that out,
and concluded that it might be propagated in milk, whereas
the cow had nothing directly to do with it.

Dr. Clark. — We have now an association of the Boards
of Health of Massachusetts. I have been interested more or
less in the matter of tuberculosis, brought about by the case
that I spoke of a few minutes ago ; and I have made some
inquiries among the various members of this association,
but have so far failed to obtain an answer in the negative
from 100 members of that Board, although I have not ob-
tained replies from all the members. But, at any rate, the
great majority of this State Board of Health Association,
made up from the members of the various Boards of Health
in Massachusetts, have stated explicitly that they think that
more legislation is demanded in regard to the subject of
tuberculosis. They believe that it is time that the State
took this matter in hand and provided adequate legislation,
so that there may be placed in authority persons to enforce
regulations in regard to tuberculosis. As I have said before,
all the legislation that we have at the present time is simply
the fact that we can quarantine animals and isolate them ;
but that will not rid the community of the disease. And,
when I say that more legislation is needed, I can speak
honestly, that it is the opinion of the majority of health
officers in this State that such a course is demanded.

The Chairman. — Is there any other gentleman here who
would like to be heard in reference to the views expressed
here this morning ? Is there anything to be said on the other

32

side of the case ? The Chair hears nothing. Mr. Motley,
I think that yon will see that it is absolutely necessary that
we should have something definite before us that we may be
able to present to the Legislature, — some ideas, some recom-
mendations, so far as legislation is concerned. When we
have that in our hands, and your report, we shall be very
glad indeed to do what we can to remedy the existing evil.
Dr. Peters, is there anything special that yon would like to
speak on for a few minutes with regard to this subject? Is
there anything more to be said ? If not, the hearing is
closed.

(Adjourned.)